Prostate Cancer Game Changer

Important new information for men with metastatic prostate cancer

Although few men are diagnosed these days with metastatic prostate cancer, it still does occur. The traditional approach to treatment has been to interfere with the male hormone called testosterone. This is called Androgen Deprivation Therapy or ADT.

It is accomplished by either removing the testicles, which produce 95% of this hormone or by injecting a drug called a Luteinizing Hormone Releasing Hormone (LHRH) agonist or antagonist. Several studies have shown that men with widespread disease who also take another drug called an anti-androgen along with the testosterone lowering treatment have a longer survival compared to men not taking it. The anti-androgen works by blocking the testosterone produced in the adrenal gland, which produces the other 5% of the body’s testosterone. Using both treatments together is called Combined Androgen Blockade (CAB) or Maximum Androgen Blockade (MAB).

Although most men with advanced disease get a response to ADT, it usually does not work forever. The median survival with this combined treatment was about 30-36 months. That means one-half the patients lived at least that long but the remainder died within that time period.

When the disease progresses, doctors call it castrate resistant prostate cancer or CRPC. The first sign is a rise in the PSA level followed by changes in the bones and/or CAT scan. Before 2004, doctors treated CRPC with a variety of treatments, but none of them had been shown to significantly improve survival. Then, in 2004 a new drug called docetaxel was approved because well-done studies showed it improved average survival. Since then, administering this drug has been the standard of care, however, the findings from a new study could soon lead to a major change in patient management.

In this new trial, men were assigned to receive either ADT alone or it was combined with docetaxel given every three weeks. The chemotherapy was continued for 18 weeks. The study recently was stopped and the results were made public because an analysis found that men getting the combined treatment lived significantly longer; at three years, 63% were alive compared to only 44% for men getting ADT alone. The best results occurred in patients with extensive widespread disease. This finding could result in men getting chemotherapy much earlier in their disease than done in the past. The FDA will probably approve it for earlier use after an application is submitted to them.

One problem, however, is that eventual approval by the FDA may complicate management in some ways. To give this treatment, urologists will have to work more closely with medical oncologists because few urologists give chemotherapy. This could delay widespread use of the combined treatments because urologists may be reluctant to encourage their patients to get chemotherapy earlier than they do now. For that reason, men with advanced disease should be aware of these results and be prepared to actively discuss the combined treatment with their physician. That way, appropriate candidates can be assured of getting this treatment.

Although a cure for advanced prostate cancer is not on the immediate horizon, patients can take some comfort in knowing that this is just one of several new therapies approved in the past few years that is offering men a longer lifespan. The median survival for men with advanced disease is now up 55 months and doctors are optimistic that it will continue to increase due to several new treatments that are under investigation.

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ABOUT THE AUTHOR

Gerald Chodak, MD

Author, Winning the Battle Against Prostate Cancer, Second Edition.
Utilizing his experience as both a clinician and an educator, Gerald Chodak, MD, is one of the leading experts on prostate cancer. Dr....read more